To determine the effect of phacoemulsification and aspiration (PEA) in different surgical settings on the posterior chamber–anterior hyaloid membrane (AHM) barrier.
Eighty enucleated porcine eyes divided into 8 groups underwent lens extraction at a bottle height of 35 or 95 cm by 1 of the following 4 procedures: standard PEA, standard PEA without hydrodissection (sPEA−), sPEA− including 5 minutes of irrigation of the anterior chamber, and sPEA− including 20 cycles of deflation (5 seconds each cycle) and inflation (10 seconds each cycle) of the anterior chamber. Distribution of gadopentetate dimeglumine (gadolinium–diethylenetriamine pentaacetic acid [Gd-DTPA]) in the irrigating fluid was assessed by magnetic resonance imaging (MRI).
The most common MRI pattern was the posterior chamber type, where Gd-DTPA was localized in the anterior and posterior chambers, followed by AHM detachment, in which Gd-DTPA was evident beneath the posterior lens capsule. The least common was AHM tear, in which Gd-DTPA entered the vitreous cavity through a tear in the AHM. Logistic regression analysis revealed prolonged irrigation (P < .001) and deflation/inflation of the anterior chamber (P < .001) as risk factors for AHM detachment and hydrodissection (P = .04) as a risk factor for AHM tear.
Changes in intraocular pressure can disrupt the posterior chamber–AHM barrier during PEA.
Cataract surgeons should reexamine their surgical settings to avoid unnecessary stress on the eye.